Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Wednesday, January 18, 2017

Please allow me to introduce myself
I'm a man of wealth and taste
I've been around for a long, long year
Stole many a man's soul and faith
- Keith Richards, Mick Jagger

Mr Peter Thiel, a Silicon Valley billionaire, apparently a man of wealth and taste, has become a major adviser to the transition team for US President-Elect Donald Trump about candidates for important government positions, including the leadership of the US Food and Drug Administration. As we noted here, Mr Theil apparently supported the candidacy of one Jim O'Neill, one of Mr Theil's business associates, for this position, despite Mr O'Neill's apparent complete lack of experience or training in medicine, health care, public health, or biomedical research, and Mr O'Neill's obvious conflicts of interest.

There's a point where no corruption can be a bad thing. It can mean things are too boring.

Think about that for a minute.

We have written about health care corruption for a long time. We use the Transparency International definition of corruption as abuse of entrusted power for private gain. We have summarized, again and again, the bad effects of corruption on health care.

In 2006, TI published a report
on health care corruption, which asserted that corruption is widespread
throughout the world, serious, and causes severe harm to patients and
society.

the scale of corruption is vast in both rich and poor countries.

Also,

Corruption might mean the difference between life and death for
those in need of urgent care. It is invariably the poor in society who
are affected most by corruption because they often cannot afford bribes
or private health care. But corruption in the richest parts of the world
also has its costs.

Very recently, Pope Francis said to an audience at a Catholic hospital (look here):

'The worst cancer in a hospital like this is corruption,' he said. 'In this world where there is so much business involved in health care, so many people are tricked by the sickness industry, 'Bambino Gesu' hospital must learn to say no. Yes, we all are sinners. Corrupt, never.'

But according to Mr Thiel, it is worse to be bored than corrupt. I suppose this may have been meant as ironic, and Mr Theil may have been affecting an Oscar Wilde like pose of cynicism. If Mr Thiel were an avant garde writer, the matter might rest there.

However, Mr Thiel is quite wealthy, and with great wealth comes power. Furthermore, Mr Thiel is now quite powerful due to his position vis a vis Mr Trump.

For someone with so much influence on the American government to say this is more than disturbing. It is despicable.

Mr Trump repeatedly proclaimed that he would drain the swamp in Washington DC. Now it seems that his proposed infrastructure projects include creating a much deeper swamp.

No Expertise Without Conflicts of Interest?

But just to ice the cake, Mr Thiel also discussed conflicts of interest.

I don’t want to dismiss ethical concerns here, but I worry that
‘conflict of interest’ gets overly weaponized in our politics. I think
in many cases, when there’s a conflict of interest, it’s an indication
that someone understands something way better than if there’s no
conflict of interest. If there’s no conflict of interest, it’s often
because you’re just not interested.

We have written ad infinitum about the web of conflicts of interest that ties together many people who make health care or health care policy decisions and rich and powerful organizations with vested interests which may conflict with patients' or the people's health. Such conflicts of interest can be regarded as the major risk factors for true corruption.

Those who want to create conflicts of interest, or who financially benefit from them, often argue that conflicts cannot be avoided, because the best and the brightest people will always have conflicts. This cynical view, apparently shared by Mr Theil, has not, to my knowledge, ever been buttressed with evidence, at least in the health care field.

Yet, as Ms Dowd pointed out, Mr Thiel

has invested in many biotech companies and has been advising the Trump transition team on science.

He is the wrong man for the job. His apparent amorality, or at best his amoral attempt at irony, predict an even more conflicted and corrupt health care system. Mr Theil may profit, but ordinary people will suffer.

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FIRM - the Foundation for Integrity and Responsibility in Medicine is a 501(c)3 that researches problems with leadership and governance in health care that threaten core values, and disseminates our findings to physicians, health care researchers and policy-makers, and the public at large. FIRM advocates representative, transparent, accountable and ethical health care governance, and hopes to empower health care professionals and patients to promote better health care leadership.

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